The University of lowa (Ul) Statewide Stroke Research Network meets the goal of the NINDS Stroke Trials Network of maximizing efficiencies in developing, promoting, and conducting high quality multi-site clinical trials on stroke prevention, treatment, and recovery. The current proposal builds on the rich tradition of the Ul as a leader in both developing and conducting NINDS-sponsored research, as well as on the Ul's role as the hub of a new integrated health care network - The Ul Health Alliance. The long-term goals of this proposal are to improve the efficiency of conducting Phase I - III stroke trials and to ensure a robust pipeline of well-trained clinical investigators to lead such trials. he proposal's immediate goal is to establish an expanded statewide research network for conducting stroke trials that reaches underserved rural patients who currently are unable to participate in stroke trials due to geographical barriers and who are subject to disparities in health outcomes. The proposed University of lowa Regional Coordinating Center (UIRCC) represents a comprehensive and integrated infrastructure for conducting trials that brings together healthcare providers, hospital administrators, clinical and health service investigators, public health officials, and patient advocates. The UIRCC comprises a network that expands the research capabilities of the Ul to 12 trial-ready sites. Those hospitals will be supplied by a statewide infrastructure of spokes that will allow adequate representation in trials of those Americans first evaluated at critical access hospitals. The UIRCC will capitalize on prior work by the PI to improve recruitment of patients presenting to critical access hospitals and maximize geographic access of patients. The feasibility of this approach is supported by the ongoing research data sharing collaboration, and a strong institutional support from the statewide healthcare alliance. We have plans already in place to expand this statewide network model to Nebraska and to the Dakotas. The UIRCC will also develop innovative translational research proposals that will lead to multicenter clinical trials through the NINDS stroke network by bringing together clinicians, early stage (i.e., bench to bedside) translational investigators, clinical trialists, epidemiologists, biostatisticians, and geographers to develop proposals of new approaches to stroke treatment, recovery, and prevention that utilize innovative methods (e.g., adaptive and pragmatic trial designs), and that focuses on the special needs of rural patients. We are particularly interested in trials testing promising therapies to augment recovery after stroke; as such treatments may have a large public health impact.